The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Correlation between Apolipoprotein B (Apob) Level and Non Alcoholic Fatty Liver in Type 2 Diabetes Mellitus with Metabolic Syndrome
No full textBackground: Non-alcoholic fatty liver disease (NAFLD) is a liver disorder commonly found in the majority of patients with metabolic risk factors, such as obesity and type 2 diabetes. Apolipoprotein B (apoB) is the moiety of low density lipoprotein (LDL) and clinical interest that provides a relative accurate estimation of circulating LDL particle. The aim of this study was to know the relationship between apoB level and occurrence of fatty liver in type 2 diabetes mellitus (DM) with metabolic syndrome. Method: A cross sectional study was conducted in patients suffered from type 2 DM with metabolic syndrome at Internal Medicine Outpatient Clinic in Moewardi Hospital Surakarta between April and May 2011. Thirty two patients with type 2 DM and metabolic syndrome were enrolled to this study and categorized into two groups; consisting of 16 patients with fatty liver and 16 patients without fatty liver. Student t-test was used in the analysis of this study. Results: Of 32 patients who fulfilled this study criteria, patients type 2 diabetes mellitus and metabolic syndrome with non-alcoholic fatty liver diseases (NAFLD) had higher apoB level than patients type 2 diabetes mellitus and metabolic syndrome without NAFLD (p = 0.013). Conclusion: NAFLD group had significantly higher apoB level than without NAFLD group in type 2 DM with metabolic syndrome patients. Keywords: apolipoprotein B, non-alcoholic fatty liver disease, type 2 DM, metabolic syndrom
Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis
No full textBackground: It has not been clear about how often the patient should have esophago- gastroduodenoscopy (EGD) screening for esophageal varices (EV) detection and there is only some data that demonstrates the correlation between the degree of EV and non-endoscopic variables. It is assumed that the presence of EV detected though examination of serum albumin level may trim down the unnecessary endoscopy. This study was aimed to recognize the correlation between albumin level and the degree of EV in patients with liver cirrhosis. Method: A retrospective analysis was performed for 61 patients with liver cirrhosis who had EGD at Sanglah hospital between January and December 2008. Spearman test was used to analyze the correlation between albumin level and the degree of EV. Results: There were 61 patients of 45 (73.8%) male and 16 (26.2%) female. The range age of patients was 13–77 years (average 49.98 ± 1.62 years). Serum albumin level ranged between 1.10-3.60 mg/dL, the average value was 2.21 ± 0.451 mg/dL. We also found 8 (13.1%) patients without EV, 14 (23.0%) patients with EV grade I, 21 (34.4%) patients with grade II and 18 (29.5%) patients with grade III. A negative correlation was found between serum albumin level and the degree of EV (r = - 0.587; p = 0.000, p < 0.01). Conclusion: Serum albumin level can predict the presence and the degree of EV in patients with liver cirrhosis. Keywords: albumin, degree of EV, liver cirrhosi
Pancreatic Pseudocyst with Colonic Perforation Complication
No full textPancreatic pseudocyst is one of complications of both acute and chronic pancreatitis. It is a rare clinical condition. The incidence is low ranging between 1.6 and 4.5%, or 0.5-1 per 100,000 adults annually. The clinical manifestations range from asymptomatic to severe acute abdomen due to complications. Acute complications may include bleeding, infection, rupture and perforation of the gastrointestinal tract; while chronic complications are gastric and biliary obstruction as well as thrombosis of portal vein. We present a case report of a 38-year-old male with complaints of abdominal pain, fatigue, nausea and vomiting containing undigested food and yellow liquid. On clilnical examination, the patient was found to be fatigue, having enlarged abdomen, unpalpable liver and spleen, no signs of shifting dullness was detected. We found an abdominal mass in the left upper and lower quadrant sized 20 x 10 cm accompanied with epigastric pain on palpation. Abdominal ultrasonography revealed a cystic lesion on the head of pancreas with differential diagnosis of pseudocyst. The abdominal computed tomography (CT-scan) showed a lesion arising from pancreas, extending into abdominal cavity and part of left groint and attaching to left intestinal in the abdomen, part of gastric region and left diaphragm. A diagnosis of pancreatitis was suspected with differential diagnosis of pancreatic mass and peritonitis. It is a case report of pancreatic pseudocyst with acute complication of colonic perforation. Keywords: pseudocyst, pancreatitis, pancreatitis complication, colonic perforatio
The Future of Acid Inhibition
No full textThere are many unmet needs with current gastric acid suppression with proton pump inhibitors (PPIs). Recommended prescription of one standard morning dose for all patients and for all medical conditions must be scientifically inappropriate and far from individualized personal medicine. For several diseases, especially gastroesophageal reflux disease and Barrett esophagus, more intense, more prolonged diurnal acid suppression is indicated. Especially inhibition of nocturnal acid secretion with our current delayed-release PPIs turns out to be difficult. This overview summarizes the actual attempts to improve the control of acid secretion, which is necessary to adapt the degree of acid inhibition to the individual patient needs. To be discussed are: immediately release PPIs, extended PPI formulations, PPIs with a much longer half-life, potassium competitive acid blockers, gastrin antagonists, etc. Future studies have to proof that those novel drug approaches indeed contribute to reduce the unmet needs. Keywords: acid secretion, PPI, nocturnal acid secretio
Prevalence of Crohns Disease in Endoscopic Unit Cipto Mangunkusumo Hospital
No full textBackground: The cumulative number of inflammatory bowel disease patients in Asia has raised three times since early 1990s, although Crohn’s disease is still less common than ulcerative colitis. The objective of this study was to provide clinical and demographic data of Crohn’s disease patients seen in Endoscopic Unit Cipto Mangunkusumo Hospital and compare the Results with other Asian countries. Method: This study was done retrospectively cross-sectional descriptive from medical records of all patients underwent colonoscopy at Endoscopic Unit, Cipto Mangunkusumo Hospital, and histological evaluation in the Department of Anatomical Pathology, Faculty of Medicine, University of Indonesia, between 2007 and 2008. Data was analyzed using SPSS version 17. Results: Of 921 patients who underwent colonoscopy, 19 (2.1%) patients were diagnosed with Crohn’s disease. There was no sex preponderance. The mean age was 47.7 years with a peak age at presentation between 51 and 60 years. The main clinical complaints were diarrhea (42.1%), lower gastrointestinal bleeding (36.8%), abdominal pain (10.5%) and upper gastrointestinal bleeding (5.3%). Colonoscopic findings were hyperemia in 94.7%, edema in 57.9%, erosions in 63.2%, ulcerations in 89.5%, pseudopolyp in 31.6%, fragile lesion in 10.5%, stenosis, fistulation, and cobblestone appearance in 5.3%. Involvement of isolated left colon was 26.3%; other manifestations were isolated right colon (10.5%), pancolitis (57.9%), ileitis (5.3%), ileocolitis (36.8%) and skip lesion (5.3%). Conclusion: The prevalence of Crohn’s disease in this study was similar to the findings in previous studies in Asian countries, with diarrhea as the main clinical complaint, and pancolitis as the dominant finding in colonoscopy examination. Keywords: Crohn’s disease, prevalence, clinical complaints, colonoscopy descriptio
Gastric Outlet Obstruction due to Peptic Ulcer Disease
No full textGastric outlet obstruction is a rare complication of peptic ulcer disease, resulting from acute or chronic inflammatory changes. Patient may present asymptomatic or may have mild gastrointestinal symptoms. Some complications may include indirect systemic disorders such as water, acid-base, and electrolyte imbalance, which could be fatal. Acute management should include gastric decompression, correction of water and electrolytes abnormalities, as well as reduction of spasm and edema by using acid-supressants. After the patient has been stabilized, more definite measures should be taken such as endoscopic dilatation or surgery and treatment of peptic ulcer itself. Nowadays, endoscopic dilatation has been performed by using through-the-scope balloon dilating catheters. The diameter of balloon is usually increased gradually over several sessions. Long-term recurrence after endoscopic baloon dilatation has been reportedly low. Keywords: peptic ulcer, gastric outlet obstruction, endoscopic baloon dilatatio
Dyspeptic Syndrome in Urban Population of Jakarta
No full textBackground: Dyspeptic syndrome is experienced by many patients who visit general practitioners and gastroenterologist. In Indonesia, a small number of epidemiological data about dyspeptic syndrome are available. The aim of this study was to obtain data on prevalence, characteristics and factors/lifestyle associated with dyspeptic syndrome in urban population of Jakarta. Method: The study was conducted by interview to 1,645 respondents representing the population of Jakarta in the year 2007 using the Steps WHO version 1.4 instruments. The selection of respondents was performed by multistage cluster random sampling, i.e. each municipality is represented by one district and each was represented by a number of villages and respondents interviewed at random. Dyspeptic syndrome is defined whenever there is one or more complaints of nausea, vomiting, belching, epigastric pain, no appetite, early satiety, bloating. Scoring was performed for each category of questions using wstep1 method prior to the analysis. Data analysis was performed with Chi-square test or t-test. Results: Of the 1,645 respondents, the prevalence of dyspeptic syndrome was 58.1%. The most apparent clinical complaint ranges consecutively, i.e. nausea 30.1%, epigastric pain 28.7%, bloating 23.8%, etc. Dyspeptic syndrome is significantly more often experienced by female respondents (p < 0.001). Dyspeptic syndrome were more common in respondents who have less/no fruit (p < 0.001) and vegetables (p = 0.049) intake. Dyspeptic syndrome is more common in respondents with anxiety and depression (p < 0.001) also in respondents who consume non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001). Conclusion: Prevalence of dyspeptic syndrome in Jakarta urban population is 58.1%. Dyspeptic syndrome was more common in female, respondents who have less / no fruit and vegetables intake, in respondents who experienced anxiety and depression and respondents who consume NSAIDs. Keywords: dyspeptic syndrome, Jakarta, urban population, prevalenc
Papilla Vaters Tumor in Elderly: an Interdisciplinary Issue
No full textTumors of the papilla Vater are very rare. Papilla Vater’s tumors are benign or malignant tumors in the ampulla of Vater and periampullary region. Blockage of ampulla leads to the development of obstructive jaundice; intermittent cholangitis, epigastric discomfort and weight loss. Treatment possibilities include endoscopic ampulectomy, surgical transduodenal excision of tumors of the ampulla and pancreatoduodenectomy (PDE). Prognosis depends on histological typing of the tumor and their clinical stage. We report a case of papilla Vater’s tumor in elderly with comorbidities based on literature review. A 68-year-old female patient was referred for evaluation of intra and extra hepatic bile duct dilatation noted on abdominal ultrasonography. She complained of intermittent epigastric and right upper abdominal pain, with yellowish skin for two months. The laboratory findings showed leukocytosis, hyperbilirubinemia, abnormal liver function test, and high Ca 19-9. An endoscopic retrograde cholangiopancreatography (ERCP) revealed a distal obstruction caused by papilla Vater’s tumor. Abdominal computed tomography (CT) with contrast, revealed a dilated common bile duct and pancreatic duct. The histologic evaluation was highly suggestive for dysplasia. She is now on a schedule for a Whipple procedure. To make a true diagnosis and optimal treatment of papilla Vater’s tumor is multimodal. By doing a comprehensive geriatric assessment, with a careful modality selection, a Whipple procedure can be performed in elderly (65 years) safely. The post operative morbidity and mortality depends on their multi morbidity. Surgical, endoscopic, or radiologic biliary decompression; relief of gastric outlet obstruction; and adequate pain control may improve the quality of life but do not affect overall survival rate. By building a great interdisciplinary teamwork, the quality of life increased as follows.Keywords: papilla Vater tumor, elderly, Whipple procedur
Result Comparison of Fecal Occult Blood Test between FOBT Hb and FOBT Hb tambah Tranferrin in Detecting Upper Gastrointestinal Tract Bleeding
No full textBackground: Immunological fecal occult blood test (FOBT) using anti human hemoglobin (Hb) has a low sensitivity in detecting upper gastrointestinal (GI) bleeding, due to Hb degradation. Transferrin (Tf) is more stable in stool when compared to Hb, provides an alternatives on diagnosing upper GI bleeding. This study aim to determine the advantage of FOBT Hb + Tf in detecting upper GI bleeding compared with FOBT Hb alone. Method: This study was conducted by comparing the diagnostic value of Rapid Immunochromatographic FOBT that use anti-human Hb alone, with the one using combination of anti human Hb & Tf simultaneously in detecting upper GI bleeding. Stool sample from 48 patients with upper GI bleeding and 29 controls (without any upper GI bleeding) were collected then tested with both FOBT Methods. Endoscopy study was used as gold standard endoscopy to determine test’s diagnostic value. Result: In detecting upper GI bleeding, the sensitivity of FOBT Hb + Tf (85.42%) was higher than FOBT Hb (29.17%). The specifity of both Methods were accurate at 89.66% and 93.10% respectively. Positive predictive values (PPV) for both Methods were also good at 93.18% and 87.50% while negative predictive value (NPV) FOBT Hb + Tf (78.79%) were higher than FOBT Hb (44.26%). Conclusion: Between these two test Methods on detecting upper GI bleeding, FOBT Hb + Tf has higher sensitivity, PPV and NPV value compared to FOBT Hb. It is advisable to use FOBT Hb + Tf for upper GI bleeding screening. Keywords: FOBT, immunochromatography, hemoglobin, transferrin, upper GI bleedin